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Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Feasibility and Clinical Utility of Low-Field Magnetic Resonance Imaging in Critically Ill Children: An Experience
Kiran Hilal1, Qalab Abbas2, Aniqa Abdul Rasool3
1Department of Radiology, Aga Khan University, Karachi, Sindh, Pakistan.
Insights
Low-field portable magnetic resonance imaging (pMRI) is a safe and feasible bedside tool for diagnosing acute brain injury (ABI) in critically ill children. This study found pMRI shows promising diagnostic accuracy compared to conventional MRI and CT scans.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Medical Imaging Technology
Background:
- Low-field portable magnetic resonance imaging (pMRI) systems are approved for clinical use, but their utility in pediatric critical care for acute brain injury (ABI) remains unevaluated.
- The diagnostic accuracy and optimal clinical applications of pMRI in critically ill children require investigation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of pMRI in detecting ABI in critically ill children.
- To compare pMRI performance against conventional MRI (cMRI) and computed tomography (CT).
Main Methods:
- A prospective diagnostic accuracy study included 88 critically ill children (1 month to <18 years) between May 2021 and June 2022.
- pMRI scans were performed within 24 hours of standard neuroimaging (cMRI or CT).
- Two independent pediatric radiologists assessed pMRI image quality and interpreted findings, blinded to standard imaging results. Diagnostic accuracy metrics included sensitivity, specificity, and agreement statistics.
Main Results:
- pMRI scans were successfully completed in 83% of patients (73/88) with a median scan time of 48 minutes, with no adverse events.
- pMRI showed good agreement with cMRI and CT for detecting edema (87%), hydrocephalus (94%), and intraparenchymal hemorrhage (87%).
- pMRI demonstrated 73% sensitivity and 98% specificity for hydrocephalus compared to cMRI. Inter-observer agreement for pMRI was high (90%). Image quality was adequate for most sequences, though diffusion-weighted imaging (DWI) had a higher rate of uninterpretable images (12.3%).
Conclusions:
- Portable magnetic resonance imaging (pMRI) is a safe and feasible bedside imaging modality for critically ill children.
- pMRI demonstrates promising diagnostic accuracy for acute brain injury (ABI) in pediatric patients, supporting its clinical utility.
Background:
Low-field portable magnetic resonance imaging (pMRI) systems have been approved for clinical use, but their feasibility, efficacy, and most appropriate clinical application in children are unknown. The objective of this study was to evaluate the diagnostic accuracy of pMRI in detecting acute brain injury (ABI) in critically ill children compared to conventional MRI (cMRI) and or computed tomography (CT).
Methods:
This prospective diagnostic accuracy study included children (1 month to < 18 years) admitted between May 2021 and June 2022 who underwent pMRI scans within a 24-h window of standard neuroimaging (CT or cMRI). pMRI images were assessed for quality of images and interpreted for findings by two independent pediatric radiologists blinded to the findings of the standard imaging modalities. Diagnostic accuracy was assessed using sensitivity, specificity, and agreement statistics.
Results:
pMRI scans were successfully completed in 83% of the cases (73 of 88 patients) with a median scan time of 48 min (interquartile range 43-54 min), with no patient- or machine-related adverse event. Neuroimaging indications were seizures in 38 (52.1%), unexplained encephalopathy in 29 (39.7%), and focal neurologic deficits in 19 (26%) patients. Radiological findings of pMRI included edema in 28 (38.4%), hydrocephalus in 12 (16.4%), infarction in 13 (17.8%), midline shift in 12 (16.4%), and intraparenchymal hemorrhage in 7 (9.6%). The pMRI demonstrated good agreement with cMRI and CT scans for detecting edema (87% agreement, κ = 0.7), hydrocephalus (94% agreement, κ = 0.8) and intraparenchymal hemorrhage (87% agreement, κ = 0.6). Compared to cMRI, pMRI showed 72% agreement (κ = 0.41, P = 0.0002), with 98% specificity and 73% sensitivity for hydrocephalus. Overall agreement between the two observers for pMRI was 90% (κ = 0.81, P < 0.001). Image quality was adequate for T1-weighted (n = 58, 79.5%), T2-weighted (n = 61, 83.6%), diffusion-weighted imaging (DWI) (n = 49, 67.1%), and apparent diffusion coefficient (n = 48, 65.8%) sequences. The highest number of uninterpretable images were for the DWI sequence (n = 9, 12.3%).
Conclusions:
pMRI is a safe and feasible bedside imaging modality that shows promising results in diagnosing ABI in children.
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